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Illinois rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.80 / $1,771.00 / $5,393.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.66 / $1,509.44 / $3,022.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$709.00 / $709.00 / $735.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.21 / $292.95 / $1,165.74
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $963.00 / $3,686.00